What Causes Supraspinatus Tendonitis

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Supraspinatus tendonitis develops when there is repetitive friction on the tendon or it is repeatedly squashed or “impinged” in the subacromial space. This leads to inflammation and gradual degeneration of the tendon. In time, tears may also develop in the supraspinatus tendon leading to a partial or complete rotator cuff tear.

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Common causes of painful arc syndrome include:

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• Repetitive Overhead Activities: activities where your arm is frequently raised, such as sports e.g. tennis and swimming, and gardening e.g. hedge trimming or pruning

• Heavy Work: Repetitive heavy lifting overhead e.g. builders and labourers

• Genetic Predisposition: hereditary link

• Injury: e.g. fall on to an outstretched hand

• Age: The subacromial space tends to narrow with age due to wear and tear 

• Primary Shoulder Impingement: Bone spurs or abnormal acromion position/shape reduce the subacromial space

• Secondary Shoulder Impingement: Dynamic shoulder instability – weakness in the rotator cuff muscles leads to poor control and thus friction

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Symptoms Of Painful Arc Syndrome

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• Mild supraspinatus tendonitis often goes unnoticed but what typically leads people to seek medical advice is shoulder and upper arm pain. Initially supraspinatus pain is usually only experienced with repetitive or sustained overhead or reaching activities. Over time, as the condition progresses, shoulder and arm pain at rest, weakness and stiffness can start to limit function. 

• Supraspinatus tendonitis symptoms may come on:

• Suddenly: after a shoulder injury

• Gradually: over time with no obvious or specific cause. 

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​Common symptoms of painful arc syndrome include:

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• Shoulder Pain: A deep aching, burning pain at the top and front of the shoulder and outer arm at rest which may radiate down the mid upper arm but rarely to the elbow. There may also be a sharp, catching pain when reaching up or moving the arm out to the side, or when twisting

• Painful Arc: An arc of pain, usually between 80-120o of shoulder abduction, when lifting the arm out to the side.
  Movement in this range, both lifting up and lowering down is typically extremely painful, but outside this range movement is often pain-free. 
  This is the classic symptom of supraspinatus tendonitis, hence the name "Painful Arc Syndrome"

• Shoulder And Arm Weakness: Considerable weakness or weakness with no pain indicates a full thickness rotator cuff tear aka supraspinatus tendon full thickness tear

• Functional Limitation: Any activities at or above shoulder height may be painful and restricted e.g. reaching up to a cupboard, hanging up washing and washing/brushing your hair

• Sleep Disturbance: night pain is common with supraspinatus tendonitis, especially when lying on the affected side

• Full PROM: Whilst pain may limit active shoulder movement, passive movement (where the arm is moved by someone else so your muscles are completely relaxed) is typically full or nearly full with pure supraspinatus tendonitis as long as there are no other shoulder impingement problems. 

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Deep Transverse Friction Massage (DTFM)​​

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• Transverse frictions are a specific type of connective tissue massage delivered transversely across the tendon fiber's. When done correctly, deep transverse friction massage helps to reduce shoulder pain and inflammation, speed up healing of the damaged supraspinatus tendon and improve function by:

• Hyperemia: Increasing local blood flow to the area

• Local Heat Effect: raising the local temperature 

• Removing Chemical Irritants: which would otherwise sensitize local nociceptors so pain receptors are less easily irritated

• Decrease Local Oedema: reducing swelling in the tendon 

• Mobilize Adhesive Scar Tissue: helps to prevent the formation of adhesions and breaks down unwanted scar tissue and abnormal cross-fiber's in the supraspinatus tendon. This helps to realign the damaged tendon fiber's in the correct position and improves tensile strength

• This helpful video from The Benjamin Institute shows the correct technique for deep transverse friction massage for supraspinatus tendonitis.

• A common misconception is that Deep Transverse Friction Massage is painful, but when done correctly this is not the case.

• Gentle pressure is used initially across the supraspinatus tendon until the area becomes numb, known as the analgesic effect. At this point the depth of pressure is gradually increased without inducing pain. The length and frequency of treatment will depend on the stage of injury.

• Transverse friction massage should only be carried out by a trained professional such as a physical therapist as success relies on a good knowledge of anatomy and structural organization of the tissue so that they can be applied to the exact site of the supraspinatus tendonitis lesions, in the correct direction and at the right depth for the appropriate duration and frequency.

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​Physical Therapy

 

 

• Anyone suffering from painful arc syndrome should see a physical therapist. They will fully assess your shoulder and identify anything which may be contributing to your shoulder problem. Physical therapy for supraspinatus tendonitis will tailored to what was found on examination and may include:

• Strengthening Exercises: for the shoulder, rotator cuff and shoulder blade muscles 

• Posture Work: to improve posture and help open up the subacromial space

• Stretching Exercises: to address any areas of muscle tightness 

• Ultrasound: to help reduce inflammation and realign tendon fiber's

• Appropriate Rest

• It is really important to avoid activities which bring on your shoulder pain to reduce the stress on the supraspinatus tendon and give it time to heal. Failure to do so increases the risk of progression to a  supraspinatus tendon full thickness tear.

• Modify Sport Techniques

• If your painful arc syndrome is linked to sport, seek expert advice on how to improve your technique to reduce the strain through the rotator cuff to prevent further irritation and supraspinatus tendon damage.

• Medication

• Painkillers and anti-inflammatories tablets or gels can help reduce pain and inflammation with painful arc syndrome.

• Ice-Cube Massage

• Massaging a wet ice-cube over the tender area for 10 minutes can help reduce localized pain and inflammation.

• Corticosteroid Injections

• An injection of steroid and local anesthetic can help to reduce pain and inflammation and aid healing with supraspinatus tendonitis.

• Steroid injections do temporarily weaken the tendon and can temporarily increase shoulder pain so it is important to take things easy for a few days and avoid any heavy lifting. You shouldn’t have more than 3 shoulder injections per year.